The Right To Assisted Suicide

Last year our society was contacted by Dr. Wallace McNeish, Senior Lecturer in the School of Social and Health Sciences at Abertay University in Dundee, to take part in a debate. Dr. McNeish and colleagues lead a highly popular module Debating the 21st Century that “aims to facilitate the development of critical thinking skills that form the basis for progression across the academic disciplines of the university.” The format of the module includes debates on difficult and contentious topics, both classic and contemporary in focus, that are lead by guest speakers invited to participate. The format includes opening arguments, rebuttals, then a question and answer session with the student audience, and closing remarks.

The topic last spring was ‘It is time that the Scottish education system became fully secular’. Our representative, Alistair McBay, former Vice President of the National Secular Society, debated for the motion, and Rev. David Robertson, former moderator of the Free Church of Scotland, debated against the motion.

We had the pleasure of being invited once again for this year’s debate, with the topic ‘Persons who wish to decide when to end their lives should be able to do so with the assistance of a registered physician’ (the first line of Margo MacDonald’s failed Assisted Suicide [Scotland] Bill). I had the privilege of arguing for the motion, and Rev. Robertson in a repeat performance, argued against the motion.

My opening argument for the support Parliamentary provisions that will allow people to request physician assistance for their own deaths.

“Good afternoon and thank you for inviting David and me to discuss one the most personal and intimate elements of our lives. I am here today as a representative of the Scottish Secular Society, although the Society does not hold the terms of this motion as a matter of policy. As a Society, we stand for freedom of religion, freedom from religion and liberty for all. To this end, a secular view on the right to Assisted Suicide is a multi-faith view that puts the desires of the individual at the helm.

“Scotland is in a unique position, regarding Assisted Suicide, because there is currently no case law or legislation, nor is there any prosecution guidance. In such cases the Crown Office and Procurator Fiscal Service (COPFS) will make a decision to prosecute.

“Assisted Suicide is also referred to as physician-assisted suicide or Assisted Dying. Given the particular focus of today’s debate, and historical precedence, I will be using the term Assisted Suicide. This is because Assisted Dying is a broad term which can encapsulate Euthanasia Euthanasia is the act of deliberately ending a person’s life to relieve suffering, which is oddly both legal and illegal in Scotland, depending on which office you consult, and which case law you reference.[1] Legally, a physician can determine your pain is too great, your illness too advanced, and your future life too short to continue treatment and, without your consent or knowledge, can put you into a medically induced coma from which you never awaken.[2]

“Assisted Suicide, which is presently illegal, is categorically different because it is done only with the person’s conscious request and consent. Let me be clear, in Scotland, it is considered morally acceptable to end someone’s life without consulting them because in your professional medically educated opinion, their quality of life is no longer good enough to try to maintain. But it is not considered morally acceptable to help someone end their own life when they themselves have decided that the quality of their own life is no longer good enough to continue and all medical consultants agree. There are many terms for this kind of moralistic legislation. “Nanny State” is one of them, “Paternalistic Law” is another.

“The Assisted Suicide [Scotland] Bill proposed by Margo MacDonald, MSP, in 2013, requested that provisions be made by an Act of the Scottish Parliament to make it lawful, in certain circumstances, to assist another to commit suicide. It has never been illegal in Scotland to commit suicide.

“Many cite the problems that have arisen and potential problems in The Netherlands since legalising Assisted Suicide and Euthanasia in 2002[3], as reasons for not allowing either in Scotland. To note, Euthanasia is also legal in Belgium, Canada, Colombia and Luxembourg, and Assisted Suicide is legal in Switzerland, Germany and six U.S. states for specific cases.[4] However, rather than being a cautionary tale of warning, the experiences in The Netherlands have been offering lessons to states debating similar legislation.

“MacDonald’s bill first made provisions to ensure no decision is made quickly, with little consideration, and little knowledge of the process, those involved, and the end result. With this, it included safeguards to ensure the decision begins, progresses, and ends with the person. Thus helping to thwart intruding opinions from family and friends, as well as other medical practitioners that would either prohibit or advance the person’s decision beyond their own desires.

“The bill proposed eight stages to the process for a person wishing to find help with their own death. A preliminary declaration is made by the person, if this is approved by a medical professional, then they must submit a first request for assistance to a physician, two independent medical practitioners must endorse the first request at different times, if these are submitted, then the person submits a second request for assistance, two independent medical practitioners must endorse the second request at different times, and finally, plans can be prepared for assisting the patient in initiating their own death.

“The bill made provisions to ensure that abuse of requesting assistance in your own suicide were in place. These took into consideration the conditions of your physical and mental states. The medical reasons can only be for (i) an illness/condition that is, for the person, progressive and either terminal or life-shortening, and of course that the person’s suffering is unbearable with no prospect of improvement. It is important to note that all the reasons given here are the same reasons given for a physician today to end your life without your knowledge or consent (such as denying CPR). It is only illegal when you become a conscious member of that decision and wish for help.

“The bill stated that in order to begin the process, a person must have the capacity to make the decision on their own. This includes all of the following (not some); the patient’s request must be voluntary and persist over time. The person must not be suffering from any mental disorders or nor medically induced states which might affect the making of the request, and is capable of (i) making the decision to make the request, (ii) communicating the decision, (iii) understanding the decision, and (iv) retaining the memory of the decision.

“You often hear with this debate, ‘Dying with dignity’. Dignity is something we strive to afford at our births. We don’t choose to be born, who we’re born to, nor the conditions under which we’re born. We are at our most fragile, both physically and mentally, and in recognising this, our laws reflect our compassion by affording as much protection and support as possible for our birth. We make extensive pre-natal preparations by medical staff, family members, and friends. We have a medical community that constantly strives to find ever-safer ways to make our births the best possible starts to our lives. And we have just as extensive post-natal care for all involved. Birth is painful. Dying is painful.

“If we’re willing to extend such compassion and dignity to the start of our lives, at a time when we have zero choice in the matter, then we deserve the same respect at the end of our lives, when we hold the most knowledge possible about ourselves. There is no good reason, no compassionate reason to force any human to suffer physically, mentally, nor emotionally until their death, when meaningful and autonomous alternatives are available.

“Our society and our laws are populated with rights and statutes specifically designed to increase personal responsibility, autonomy, and respect. There is arguably nothing greater than the right to your own life. And as Marcus Aurelius recognised 2000 years ago, “The act of dying is one of the acts of life.” We have the right to accept, refuse or discontinue medical treatment. We should have the same right to decide when and where our lives end.

“A survey last year showed that 75% of Scots support a change in the law on assisted suicide that will allow doctors to help terminally ill people end their lives. For over 30 years, survey after survey has shown that people in the UK support the view that a doctor should be able to assist a patient, with a terminal or incurable disease, to end their life at the patient’s request.[5] Legislative reform regarding these issues have historically lagged behind the development of public opinion and medical practice.

“Choice should include access to high quality palliative care, the right to specify in advance what treatment should be withheld or when it should be withdrawn – such as DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and Living Wills – and, for the terminally ill and incurably suffering, the right to request medical assistance to die at a time and in a manner of their choosing.”

My rebuttal was more tailored to claims within Rev. Robertson’s opening remarks: suicide is illegal in Scotland (misconstruing forced medical observation with criminal and civil prosecution), euthanasia and assisted suicide are the same thing, neither law nor medicine are perfect (so we shouldn’t adopt new practices), the culture of medicine will change (implying it shouldn’t) and this will allow the state to determine when you die, and that he doesn’t want death busses roaming the neighbourhoods killing any family member you we don’t like.

“The arguments for Assisted Suicide are categorically and moralistically different than those for Euthanasia. If we’re to use the definitions of the NHS and Scottish Government, Assisted Suicide is someone consciously asking for help in their own death in order to relieve their unliveable suffering. Euthanasia is someone else deciding a person’s death without their consent, in order to relieve their unliveable suffering. To argue the legality of one, is not the same as arguing the legality of both. They are separate acts that treat the most important element, the conscious choice of the person, differently. Every one of our criminal laws to date take this one element into consideration when determining fault and sentencing. Murder vs. Manslaughter, Intention vs. Accident.

“A practice not being perfect has never stopped our laws from being written and amended. There is no perfection in medicine, but that hasn’t stopped us from allowing medical professionals from practicing medicine. The simple claim that it’s not a perfect system, therefore it shouldn’t be allowed is not sufficient enough to abstain entirely from discussions. Rather, much in line with MacDonald’s bill, and every other law we have, provisions are clearly set, every aspect of the process is attempted to be accounted for, including oversight, new training protocols, secondary provisions, allowances and penalties. And amendments are made when necessary. A good and effective law is not made in a vacuum, nor does it exist in one. The Assisted Suicide Bill presented a holistic effort that involved a whole host of practitioners, checks, and protections.

“The argument that this will change the culture of medicine and how its practiced makes an assumption that how medicine is practiced today is somehow more right than any other version we could adopt. Every leap in medical discovery has changed the culture in which medicine is practice. Vaccines, antibiotics, discovery of germs, discovery of penicillin, the invention of plastics, recognition of patients’ rights, even allowing women in medical school, all these have changed the face of medicine. With this, legislation has evolved and amended in tandem, to find ‘best practice’ policies that benefit both profession and patient. The argument that how we practice today is somehow the final evolution of medicine is not only myopic in perspective, it entirely negates the history of medicine. The medicine practiced 100 years ago is barely recognisable to the medicine we practice today. And all of those changes, in conjunction with other lifestyle changes, have increased our collective quality of life, by comparison. Opening discussions to the allowance of Assisted Suicide is just one of the next steps in the evolving relationship we each have with our medical community.

“The General Medical Council stated that there is no absolute obligation for your doctor to prolong life. Dr. Vivienne Nathanson, director of professional activities at the BMA and a fellow of the Royal College of Physicians explained that forcing doctors to administer treatments just because they can (like performing CPR to resuscitate), rather than because they will make a difference, institutes a lack of dignity for the patient. And that ethically, doctors should not do anything to a patient that will not benefit the patient.[6] What this means is that in Scotland regardless of what you ask for from your doctor, if your doctor doesn’t consider it beneficial to improving the quality of your life, your doctor is not obligated to do it. Yet we still go to our doctors, we still seek treatment for our ailments, we still check into hospitals. If knowing your doctor can already do whatever s/he wants with regard to your death, it is quite debatable that the average Scotsman will suddenly lose all faith in their doctor when they’re now allowed to listen to and support your personal wishes regarding the nature of your death.

“Assisted Suicide is a medical, right to death, provision held only for the person. Family members, doctors, friends, politicians, no one else can make the decision for your death. Assisted Suicide can only be carried out on the explicit request of the person wishing to die by their own schedule and means. So this idea that family members and doctors will start seeing people as throw-away members of society is not even a factor in Assisted Suicide legislation. There is an argument that being allowed to see yourself as having the right to end your own suffering with the aid of another person will cause an internalising attitude that you’re a burden, and this will manifest as wanting to end your life when you otherwise wouldn’t. As it stands, we all have the right to end our own lives. This is considered a basic human right. There was a time, however, when this was illegal. If this argument stands, then the rates of suicide should have gone up, and continued to rise once suicides were decriminalised. The Suicide Act of 1961[7], however, saw a small spike in suicides for a few months, mostly using newly available prescription drugs, then the numbers fell continuously for the next 15 years, and continue to fall for women in particular.[8] So according to our own human behaviour, decriminalising personal choice of death, does not increase our willingness to die. And the demographic with the highest rate of suicides? People over the age of 80. End of life, personal choice.”

Closing remarks

“We are all going to die someday. There is both a comfort and fear in that certainty. The best we can ever do for ourselves and for each other, is to strive to ensure our deaths are not entered into with pain. Pain from loneliness. Pain from cruelty. Pain from illness. Choosing our deaths is an inalienable right, whether we exercise that right or not. Allowing a privileged few to help us to our chosen deaths is one of the most intimate gifts we could bestow on another.

“Assisted Suicide is a right that advantages a remarkably small minority. Perhaps this is why we take such issue with the concept. Most of us, arguably everyone in this room, will never need this provision in our lives. In our deaths. However, a compassionate people will always recognise the needs of the few as strongly as the needs of the many.

“Thank you.”

If you would like more information on your rights, or have some questions, your best source in Scotland can be found with our colleagues at Friends At The End.